Provider Demographics
NPI:1457973448
Name:TRUMBULL, BRENDA LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEIGH
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 BOXELDER DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-7590
Mailing Address - Country:US
Mailing Address - Phone:937-716-8987
Mailing Address - Fax:
Practice Address - Street 1:4230 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-2204
Practice Address - Country:US
Practice Address - Phone:937-204-1781
Practice Address - Fax:937-963-0952
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026717363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care